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Ask an Eye M.D. Answer Archive

Question:My right eye has developed two big brown spots on the white of my eye which is very annoying to me. They're not hurting or causing any vision problems, yet, I can't stand having them for aesthetic reasons. Is there any treatment or surgery that can get rid of them? Are they dangerous?

Answer:There are numerous possible causes of discoloration of the conjunctiva, or white portion of the visible eyeball. By far, the vast majority of such pigmentations are totally benign. However, the only way to be certain is to have a careful examination by an ophthalmologist who can differentiate between the subtle differences and possibilities. Amongst the possibilities:

Benign conjunctival nevi are common and usually develop during the first decade of life.

PAM, or Primary Acquired Melanosis, typically develops in middle-aged or elderly white patients. It is almost always unilateral flat indistinct areas of conjunctival pigmentation. PAM may remain stable for years or possibly undergo color changes or even a malignant transformation. This uncommon transformation is an important reason that pigment changes must be monitored by an ophthalmologist.

Certain medications, both systemic and topical, such as epinephrine-containing eye drops, may darken the conjunctiva. Industrial or photographic use of silver preparations may lead to conjunctival discoloration. Systemic endocrine diseases and hormonal changes such as accompany pregnancy may lead to melanin production, which can cause progressive darkening of the skin and even the conjunctiva.

Finally, changes in conjunctival pigment must be carefully evaluated to exclude the possibility of malignant melanoma of the conjunctiva. Though uncommon, malignancies can arise from the acquired melanosis above, or a nevus, or without a precursor. Such an uncommon mass is most common in middle-aged to elderly patients. The lesion may be vascularized with dilated vessels feeding the tumor.